Eythorsson Elias, Bjarnadottir Valgerdur, Runolfsdottir Hrafnhildur Linnet, Helgason Dadi, Ingvarsson Ragnar Freyr, Bjornsson Helgi K, Olafsdottir Lovisa Bjork, Bjarnadottir Solveig, Agustsson Arnar Snaer, Oskarsdottir Kristin, Thorvaldsson Hrafn Hliddal, Kristjansdottir Gudrun, Bjornsson Aron Hjalti, Emilsdottir Arna R, Armannsdottir Brynja, Gudlaugsson Olafur, Hansdottir Sif, Gottfredsson Magnus, Bjarnason Agnar, Sigurdsson Martin I, Indridason Olafur S, Palsson Runolfur
Landspitali-The National University Hospital of Iceland, Reykjavik, Iceland.
Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavik, Iceland.
Diagn Progn Res. 2022 Sep 8;6(1):17. doi: 10.1186/s41512-022-00130-0.
The severity of SARS-CoV-2 infection varies from asymptomatic state to severe respiratory failure and the clinical course is difficult to predict. The aim of the study was to develop a prognostic model to predict the severity of COVID-19 in unvaccinated adults at the time of diagnosis.
All SARS-CoV-2-positive adults in Iceland were prospectively enrolled into a telehealth service at diagnosis. A multivariable proportional-odds logistic regression model was derived from information obtained during the enrollment interview of those diagnosed between February 27 and December 31, 2020 who met the inclusion criteria. Outcomes were defined on an ordinal scale: (1) no need for escalation of care during follow-up; (2) need for urgent care visit; (3) hospitalization; and (4) admission to intensive care unit (ICU) or death. Missing data were multiply imputed using chained equations and the model was internally validated using bootstrapping techniques. Decision curve analysis was performed.
The prognostic model was derived from 4756 SARS-CoV-2-positive persons. In total, 375 (7.9%) only required urgent care visits, 188 (4.0%) were hospitalized and 50 (1.1%) were either admitted to ICU or died due to complications of COVID-19. The model included age, sex, body mass index (BMI), current smoking, underlying conditions, and symptoms and clinical severity score at enrollment. On internal validation, the optimism-corrected Nagelkerke's R was 23.4% (95%CI, 22.7-24.2), the C-statistic was 0.793 (95%CI, 0.789-0.797) and the calibration slope was 0.97 (95%CI, 0.96-0.98). Outcome-specific indices were for urgent care visit or worse (calibration intercept -0.04 [95%CI, -0.06 to -0.02], E 0.014 [95%CI, 0.008-0.020]), hospitalization or worse (calibration intercept -0.06 [95%CI, -0.12 to -0.03], E 0.018 [95%CI, 0.010-0.027]), and ICU admission or death (calibration intercept -0.10 [95%CI, -0.15 to -0.04] and E 0.027 [95%CI, 0.013-0.041]).
Our prognostic model can accurately predict the later need for urgent outpatient evaluation, hospitalization, and ICU admission and death among unvaccinated SARS-CoV-2-positive adults in the general population at the time of diagnosis, using information obtained by telephone interview.
严重急性呼吸综合征冠状病毒2（SARS-CoV-2）感染的严重程度从无症状状态到严重呼吸衰竭不等，临床病程难以预测。本研究的目的是建立一个预后模型，以预测未接种疫苗的成年人在诊断时感染新型冠状病毒肺炎（COVID-19）的严重程度。
冰岛所有SARS-CoV-2检测呈阳性的成年人在诊断时均被前瞻性纳入一项远程医疗服务。多变量比例优势逻辑回归模型是根据2020年2月27日至12月31日期间符合纳入标准的确诊者在入组访谈中获得的信息推导出来的。结局按顺序量表定义：（1）随访期间无需升级护理；（2）需要紧急就诊；（3）住院；（4）入住重症监护病房（ICU）或死亡。缺失数据使用链式方程进行多重填补，模型使用自助法进行内部验证。进行决策曲线分析。
预后模型来自4756名SARS-CoV-2检测呈阳性的人。总共375人（7.9%）仅需要紧急就诊，188人（4.0%）住院，50人（1.1%）入住ICU或因COVID-19并发症死亡。该模型包括年龄、性别、体重指数（BMI）、当前吸烟状况、基础疾病以及入组时的症状和临床严重程度评分。在内部验证中，经乐观校正的纳格尔克R为23.4%（95%置信区间，22.7 - 24.2），C统计量为0.793（95%置信区间，0.789 - 0.797），校准斜率为0.97（95%置信区间，0.96 - 0.98）。特定结局指标为紧急就诊或更差情况（校准截距 -0.04 [95%置信区间，-0.06至-0.02]，E 0.014 [95%置信区间，0.008 - 0.020]）、住院或更差情况（校准截距 -0.06 [95%置信区间，-0.12至-0.03]，E 0.018 [95%置信区间，0.010 - 0.027]）以及入住ICU或死亡（校准截距 -0.10 [95%置信区间，-0.15至-0.04]，E 0.027 [95%置信区间，0.013 - 0.041]）。
我们的预后模型可以通过电话访谈获得的信息，准确预测普通人群中未接种疫苗的SARS-CoV-2检测呈阳性成年人在诊断时后期对紧急门诊评估、住院、入住ICU以及死亡的需求。
